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Studies designed to provide insight into clinical practice in the real world are known as pragmatic trials. They are typically characterized by a focus on the practical aspects of the study design, such as recruitment and consent as well as adherence to the use of standard equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which used a variety of investigators and participants from various geographical areas. This type of heterogeneity which is essential for a pragmatic trial to be reliable and to reduce bias in the results is also essential. However, too much heterogeneity can lead to problems with the design of the trial.

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Pragmatic trials are designed to replicate real-life settings and achieve maximum external validity. They are typically commissioned by practitioners and policy makers to guide their decision-making. They can also be used to assess the causal relationship between an intervention with its outcomes. However, they should not be used to replace the need for explanation studies.

The pragmatism idea is controversial, and there are questions regarding whether pragmatic trials could be used to replace explanation tests or if they are a complement to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which confirm a physiological or clinical hypothesis, and pragmatic trials, which inform the practice and policy decisions. They also suggested a framework dubbed PRECIS for pragmatic trials.2 The tool was designed to define the elements of a pragmatic research study that includes recruitment, design, implementation of the intervention and follow-up.

There is an encouraging trend in the number of pragmatic trials that are published. A recent Medline search using the terms pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This is an indication that the health sciences community is becoming increasingly sensitized to the subject of pragmatic thinking. However, it is important to keep in mind that the majority of these trials were conducted in primary care settings.